Comparison of Local Infiltration of Bupivacaine and Tramadol in post-operative pain management in children after inguinal herniotomyasif Iqbal, Naeem LiaqatPages 54-60Abstract Full Text [PDF 318KB]

INTRODUCTION

Adequate pain control is essential in immediate post-operative period. Different methods are being used to provide pain management but none of these is completely effective. Regional blocks are becoming more popular then systemic opioids in all age groups due to efficacy and safety of agents used.

OBJECTIVE

The objective of this study was to determine the effectiveness of tramadol and bupivacaine for post-operative analgesia after inguinal herniotomy in children.

Material &

Method

This was a randomized controlled trial conducted at pediatric surgery department، services hospital Lahore over 2years. 284 cases randomly divided in two groups B (Bupivacaine) & T (Tramadol). Bupivacaine (dose of 3 mg/kg) in group B or Tramadol (2mg/kg) in group T was infiltrated in the wound. Postoperatively pain score was measured using Wong-Baker Faces pain scale at 0،1،2،4 and 8 hours. Side effects were noted in both groups.

Results

Age and gender distribution in both the groups were comparable. Pain score noted in both Groups was equal in both groups at 0- hours. however at 1-hour، 2-hour and 4-hour، pain score was slightly more in Group-B. But at 8-hours mean pain score was markedly raised in Group-B as compared to Group-T (3.32 ± 1.42 vs 2.45 ± 1.35). Only complication noted in patients was vomiting which was higher in Group T.

CONCLUSION

Locally infiltrated Tramadol is a better choice than bupivacaine as a local anesthetic for pain management in children after inguinal herniotomy. Further research is needed to elucidate any benefits it may have in other surgeries.

Ketamine is a medication that suppresses the central nervous system and can be used as an analgesic. The aim of this study isto compare the post-operative pain reduction of rectal ketamine and caudal bupivacaine in pediatric lower abdominal surgery.

Method

This was a double-blind clinical trial studywhich performed on 68 children aged 1-7 years that allocated into two groups of 34 patients. The first Group received rectal ketamine (2mg/kg)، and the second received 0.75mg/kg caudal bupivacaine (0.125%). Mean pain intensity and hemodynamic variables were recorded 2،6،12 and 24 hours after lower abdominal surgery in children. Pain was assessed using FLACC (Face، Legs، Activity، Cry، Consolability) Scale.

Results

No significant difference was found in terms of pain intensity between admission and discharge from recovery (p>0.05). Patients who received ketamine endured less pain than bupivacaine 2، 6، and 12 hours following surgery (p<0.05). Mean extubation time and duration of recovery stay was significantly shorter in ketamine group.

Conclusion

Rectal ketamine was associated with more effective pain control and shorter recovery stay، when compared to caudal bupivacaine in lower abdominal pediatric surgery.

The purpose of this study، is evaluation of the average of cumulative radiation exposure in admitted neonates in neonatal surgery ward

Material and method:

Participants were all neonates consecutively admitted to the neonatal surgery unit of the study hospital for surgery and need one type of radiological study during hospitalization. Thermo luminescent dosimeters (TLD GR200) were used for evaluating absorbed dose of radiation on the body. For controlling of confounding variables، 130 admitted neonates who need no radiation were selected as control group.

Results:

In this study، we evaluated 169 neonates.The most x -ray examination was on ribcage (338 cases). Total amount of bowel and backbone x-ray examinations were 117 and 11 respectively. Total amount of contrast enema، meal and swallow was 8، 9 and 5 respectively. The cumulative absorbed dose in 19 patients was more than 10 mSv. There was a significant differences between control group with other x ray examination groups(p=0.001). The mean of accumulated received dose for patients during admission period was 3.13±5.12 mSv.

Conclusion:

The average of accumulated received dose for neonates was about 3.13 mSv. Although this dose is less than annual limit dose، but it is inacceptable in comparison with other medical centers

The management of long-gap esophageal atresia (LGEA) remains challenging and esophageal replacement is necessary in a number of cases، with the conduit of choice for potential surgical expertise. The current study aimed at assessing the outcomes of gastric pull-up surgery for esophageal reconstruction in children with LGEA، and investigating the postoperative results، complications، and mortality.

Materials and Methods

Sixteen patients with LGEA were studied at Tabriz Children’s Hospital، Tabriz، Iran. Gastric pull-up technique was used for esophageal replacement in all the patients. The study duration was 23 months from April 2014 to March 2016.

Results

The mean age of the patients was 7.31 ± 3.91 days. Eleven patients (68.75%) were male and five (31.25%) female. Seven patients (43.75%) had esophageal atresia type A and nine patients (56.25%) had the type C. All patients (100%) were in need for postoperative mechanical ventilation. Mean period of postoperative mechanical ventilation was5.69 ± 0.87 days. Postoperative mortality was observed in three patients (18.75%). Patients were followed up for six months after the operation; poor feeding was observed in four patients(30.77%) ، mild respiratory distress in three patients (23.08%)، and choking and aspiration in three patients (%23.08).

Conclusion

It was observed that gastric pull-up technique was a feasible and safe surgical method for patients with long-gap esophageal atresia when primary anastomosis was not possible. Quality of life، feeding، and growth pattern were also acceptable. However، long-term outcomes were not assessed in the current study.

Evaluation of the catheter tip position among children with totally implantable port during 2015 in Dr. Sheikh Children?s hospitalReza Shojaeian, mohammad mahdi khazraviPages 88-92Abstract Full Text [PDF 488KB]

Background

Totally implantable port insertion is a common procedure in pediatrics surgery and the main concern is the tip catheter position، which is directly related to its complications، failure and durability. The best position is in SVC/RA junction which is compatible with carina or T5-T6 vertebral level in X-ray.

In our center we routinely use surface anatomy to estimate the adequate length for the tip to reach SVC/RA junction. In this study we compared the precision and accuracy of this method by post-operative X-ray study.

Materials and methods

as a retrospective study we evaluated the accuracy of surface anatomical land marks to estimate the catheter tip position، considering the carina or vertebra in X-rays which represents the SVC/RA junction. 48 patients were included and their records were reviewed in Dr. Sheikh Children’s hospital (Mashhad).

Results

Considering the carina as the best radiographic land mark، we had accurate tip position just in 29.2%،over insertion in 45.8% and under inserted catheter tip in 10.4%.Considering the vertebral bodies as radiographic land mark،50% were over inserted ،35.4% accurate and 14.6% under inserted.

Conclusion

Regarding our high rate of catheter tip mal-position arising from considering surface anatomy alone، we suggest not only to rely on surface anatomy but use imaging modalities such as portable X-ray، fluoroscopy or ultra-Sonography within the operation room while inserting implantable port devices.

The aim of this study was to evaluate clinical manifestation، and outcome of biliary tract disease in patients that referred for treatment in two referral centers of pediatric surgery of Ahvaz.

Patients and

methods

This retrospective study was done in Imam Khomeini and Abuzar hospitals، two referral centers for pediatric surgery in Ahvaz. Duration of study was 10 years starting from 1st March 2000. Patients who admitted due to biliary tract disease were included in this study. Age، sex، clinical manifestation، type of surgery، imaging finding، laboratory finding، duration of hospital staying، blood product infusion، and mortality rate were recorded. Data were entered to SPSS Ver 13.0( Chicago، IL،USA). Chi-square and t-test were used for comparison.

Results

Twenty cases (m=13، f=7) of biliary atresia were included in this study. Mean of age at time of diagnosis and operation was 82.11 days (30 days- 6.5 months). Jaundice (100%)، acholic stool (55%)، and dark brown urine(55%) were the most frequent clinical manifestation in patients with biliary atresia. Of all cases، 17 patients underwent surgery. Eighteen cases (m=11، f=7) of cholecystitis were included in this study. Abdominal pain (72%) is the most frequent sign. Eleven cases underwent surgery. Five cases of choledochal cyst (m=0، f=5) were included in this study. Abdominal pain and vomiting is the most common clinical manifestation in cases with choledocal cyst.

Conclusion

Jaundice، acholic stool، and dark brown urine were the most frequent clinical manifestation in cases with biliary atresia. Mean age at the time of diagnosis and operation for BA cases was 82.11 days (30 days- 6.5 months). Abdominal pain was the most frequent sign of cholecystitis. Early referral and increasing experiences are recommended to increase survival for BA cases in our hospital

Rectal adenocarcinoma is rare in children. The patient described here is a 9-year-old girl presented with rectorrhagia. Her problem started since 3 months ago and she had been treated for infectious diarrhea. A colonoscopy was performed 3 months after beginning of the patient’s manifestation and a non-pedunculated polyp was noted and resected. After the colonoscopy signs and symptoms of peritonitis developed and in laparotomy a rectal perforation was noted and a biopsy from rectal mucosa carried out. The result of biopsy was adenocarcinoma and then a low anterior resection of rectum with protective ileostomy and chemotherapy performed. In the 15 months follow-ups the patient was alright without any clinical، radiological or laboratory signs or symptoms of tumoral recurrence. However rectal adenocarcinoma is rare but it should be considered in the differential diagnosis of intestinal problems.

Disorders related to Bartholin's duct and glands affecting approximately 2% of women، mostly in reproductive years، and are very rare in premenarchal girls. Bartholin's gland cysts are most often small، not causing any symptoms and passed spontaneously. However، symptomatic larger cysts require medical treatment. Although there are many treatment modalities for this condition، the best approach is yet to be established. Treatment modalities of Bartholin's cyst include incision and drainage of the cyst، application of silver nitrate to the abscess cavity، curettage of the abscess cavity، placement of Word catheter، marsupialization، needle aspiration and alcohol sclerotheraphy، carbon dioxide laser excision and surgical gland excision. Here، we report a case of a large، soft، regular contoured painless Bartholin's cyst located in the left labia minora with a diameter of 8 x 5 cm in a 11-year-old premenarchal girl، treated by surgical gland excision after previous unsuccessful incision and aspiration of the cyst.